scholarly journals Intestinal Ultrasound in Pediatric Inflammatory Bowel Disease: Promising, but Work in Progress

2021 ◽  
Author(s):  
Elsa A van Wassenaer ◽  
Marc A Benninga ◽  
Johan L van Limbergen ◽  
Geert R D’Haens ◽  
Anne M Griffiths ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Point Of Care ◽  
Pediatric Population ◽  
Current Evidence ◽  
Inflammatory Bowel ◽  
Diagnostic Modalities ◽  
Predict Treatment Response ◽  
Additional Point

Abstract Intestinal ultrasound (IUS) is increasingly used and promulgated as a noninvasive monitoring tool for children with inflammatory bowel disease because other diagnostic modalities such as colonoscopy and magnetic resonance imaging cause significant stress in the pediatric population. The most important parameters of inflammation that can be assessed using IUS are bowel wall thickness and hyperemia of the bowel wall. Research has shown that IUS has the potential to be a valuable additional point-of-care tool to guide treatment choice and to monitor and predict treatment response, although evidence of its accuracy and value in clinical practice is still limited. This review gives an update and overview of the current evidence on the use and accuracy of IUS in children with inflammatory bowel disease.

scholarly journals P190 Systematic review: Gastrointestinal ultrasound scoring indices for inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S233-S233
Author(s):  
T Goodsall ◽  
T Nguyen ◽  
C Ma ◽  
V Jairath ◽  
R Bryant
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Observer Agreement ◽  
Current Evidence ◽  
Reference Standard ◽  
Disease Phenotype ◽  
Gastrointestinal Ultrasound ◽  
Inflammatory Bowel

Abstract Background The management of inflammatory bowel disease (IBD) requires frequent monitoring and assessment of disease activity. Endoscopic assessment with biopsy remains the gold standard for disease activity. Gastrointestinal ultrasound (GIUS) is a non-invasive, accessible and affordable test used to assess and monitor IBD and has been shown to be similar to MRI for detecting disease. The aim of this study was to systematically review the literature to identify scoring indices used for GIUS measurement of disease activity in IBD and to appraise their operating characteristics. Methods A systematic search of Embase, Medline, Pubmed, Cochrane Central and Clinical Trials.gov from inception to July 2019 was conducted according to PRISMA guidelines. Included were all study types reporting GIUS indices used for grading activity of severity of IBD in comparison to an objective reference standard. Studies using an exclusive clinical reference standard were excluded. All study types and abstracts were considered. Study quality was assessed using the QUADAS tool. Results 27 eligible studies were identified investigating 1647 patients. Disease phenotype was Crohn’s disease (CD) (n = 13), ulcerative colitis (UC) (n = 10) and IBD (n = 4). The most common reference standard was colonoscopy (n = 23), histology (n = 2), and imaging (n = 2). Bowel wall thickness was an index parameter in 26 studies. The most frequent cut off was 3mm (n = 10), 4mm (n = 9), 5mm (n = 1), and not specified (n = 6). There was no noticeable difference in magnitude of cut off when stratified by disease phenotype. Colour Doppler was an index parameter in 16 studies and was based on the Limburg score (n = 7), binary (n = 7) or categorical (n = 2). Bowel wall stratification was an index parameter in 15 studies and was more frequently used in UC (70%) and IBD (75%) indices than in CD indices (38%). Other index parameters included bowel wall compressibility, presence of complications such as abscess or fistula, bowel wall echogenicity, mesenteric inflammatory, lymphadenopathy, contrast enhancement, ulceration, peristalsis, strictures, absence of haustra coli, and tissue sonoelastography. Twenty-three studies were identified as at risk of bias. Overall concordance was substantial to excellent and accuracy was good to excellent. Two studies demonstrated substantial inter-observer agreement. No studies reported intra-observer agreement. Conclusion The identified GIUS scoring indices demonstrate applicability to both CD and UC with good accuracy and concordance. Current evidence does not adequately address concerns about the intra- and inter-observer variability of GIUS. There is a need for robust validation of an evidence-based GIUS index before more widespread use in IBD as a surrogate for colonoscopy and in clinical trials.

scholarly journals Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

2020 ◽  
Vol 4 (1) ◽  
pp. e000786
Author(s):  
Abbie Maclean ◽  
James J Ashton ◽  
Vikki Garrick ◽  
R Mark Beattie ◽  
Richard Hansen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
High Standard ◽  
Current Evidence ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
Working Practices ◽  
The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

scholarly journals Food and Food Groups in Inflammatory Bowel Disease (IBD): The Design of the Groningen Anti-Inflammatory Diet (GrAID)

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1067
Author(s):  
Marjo J. E. Campmans-Kuijpers ◽  
Gerard Dijkstra
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Food Group ◽  
Dietary Guidelines ◽  
Current Evidence ◽  
Group Level ◽  
Food Groups ◽  
Inflammatory Bowel ◽  
Anti Inflammatory

Diet plays a pivotal role in the onset and course of inflammatory bowel disease (IBD). Patients are keen to know what to eat to reduce symptoms and flares, but dietary guidelines are lacking. To advice patients, an overview of the current evidence on food (group) level is needed. This narrative review studies the effects of food (groups) on the onset and course of IBD and if not available the effects in healthy subjects or animal and in vitro IBD models. Based on this evidence the Groningen anti-inflammatory diet (GrAID) was designed and compared on food (group) level to other existing IBD diets. Although on several foods conflicting results were found, this review provides patients a good overview. Based on this evidence, the GrAID consists of lean meat, eggs, fish, plain dairy (such as milk, yoghurt, kefir and hard cheeses), fruit, vegetables, legumes, wheat, coffee, tea and honey. Red meat, other dairy products and sugar should be limited. Canned and processed foods, alcohol and sweetened beverages should be avoided. This comprehensive review focuses on anti-inflammatory properties of foods providing IBD patients with the best evidence on which foods they should eat or avoid to reduce flares. This was used to design the GrAID.

scholarly journals Patients’ Diets and Preferences in a Pediatric Population with Inflammatory Bowel Disease

1998 ◽  
Vol 12 (8) ◽  
pp. 544-549 ◽  
Author(s):  
Timothy J Green ◽  
Robert M Issenman ◽  
Kevan Jacobson
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Population ◽  
Symptomatic Relief ◽  
Sole Source ◽  
Dietary Practices ◽  
Pediatric Inflammatory Bowel Disease ◽  
Diet Supplement ◽  
Corn Products ◽  
Inflammatory Bowel

PURPOSE: To determine the dietary practices of the pediatric inflammatory bowel disease population at the Children's Hospital of the Hamilton Health Sciences Corporation and the reported effectiveness of those diets.PATIENTS AND METHODS: A questionnaire mailed to 153 pediatric patients was returned by 125 patients (76 Crohn's disease [CD] and 49 ulcerative colitis [UC] patients) - an 82% response rate.RESULTS: The median age of respondents was 13 years, and 62% were male. Ninety per cent and 71% of CD and UC patients, respectively, had changed their diets since diagnosis. Caloric supplements (eg, BOOST [Mead Johnson Nutritionals]), sole source nutrition, low fibre and lactose-free diets were used by more than 15% of CD patients, whereas lactose-free, nonspicy, low acid, additive-free, caloric supplement and low fibre diets were used by more than 15% of UC patients. A diet supplement was more commonly used in CD patients (P<0.05) and an additive-free diet in UC patients. Corn and corn products, nuts, milk and bran were avoided by more than 20% of CD and UC patients; however, more CD than UC patients avoided corn and corn products. In addition, UC patients (more than 20%) also avoided tomato, other dairy (nonfluid milk-based products and foods containing milk products), chocolate, cheese, wheat, tomato sauces and fruit juice. A benefit was reported for 103 of 141 reported diets, with the most commonly alleviated symptoms being abdominal pain, diarrhea and flatulence.CONCLUSION: Many children with inflammatory bowel disease have altered their diets to manage their disease and have attributed symptomatic relief to these diets.

scholarly journals Quantitative contrast-enhanced ultrasound for monitoring vedolizumab therapy in inflammatory bowel disease patients: a pilot study

2018 ◽  
Vol 59 (10) ◽  
pp. 1149-1156 ◽  
Author(s):  
Ruediger S Goertz ◽  
Daniel Klett ◽  
Dane Wildner ◽  
Raja Atreya ◽  
Markus F Neurath ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Color Doppler ◽  
Response To Treatment ◽  
Clinical Activity ◽  
Contrast Enhanced Ultrasound ◽  
Software Analysis ◽  
Contrast Enhanced ◽  
Inflammatory Bowel

Background Microvascularization of the bowel wall can be visualized and quantified non-invasively by software-assisted analysis of derived time-intensity curves. Purpose To perform software-based quantification of bowel wall perfusion using quantitative contrast-enhanced ultrasound (CEUS) according to clinical response in patients with inflammatory bowel disease treated with vedolizumab. Material and Methods In a prospective study, in 18 out of 34 patients, high-frequency ultrasound of bowel wall thickness using color Doppler flow combined with CEUS was performed at baseline and after 14 weeks of treatment with vedolizumab. Clinical activity scores at week 14 were used to differentiate between responders and non-responders. CEUS parameters were calculated by software analysis of the video loops. Results Nine of 18 patients (11 with Crohn’s disease and seven with ulcerative colitis) showed response to treatment with vedolizumab. Overall, the responder group showed a significant decrease in the semi-quantitative color Doppler vascularization score. Amplitude-derived CEUS parameters of mural microvascularization such as peak enhancement or wash-in rate decreased in responders, in contrast with non-responders. Time-derived parameters remained stable or increased during treatment in all patients. Conclusion Analysis of bowel microvascularization by CEUS shows statistically significant changes in the wash-in-rate related to response of vedolizumab therapy.

Epigenetic Modifications of the Nuclear Factor Kappa B Signalling Pathway and its Impact on Inflammatory Bowel Disease

2021 ◽  
Vol 27 ◽  
Author(s):  
Stamatia Papoutsopoulou ◽  
Barry J. Campbell
Keyword(s):  
Dna Methylation ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Nuclear Factor Kappa B ◽  
Intestinal Inflammation ◽  
Alternative Pathway ◽  
Current Evidence ◽  
Nuclear Factor ◽  
Nuclear Factor Kappa ◽  
Inflammatory Bowel

Background: Inflammatory bowel disease (IBD) is a multifactorial condition influenced by the immune system, the intestinal microbiota, environmental factors, genetic and epigenetic factors. Genetic- and environment-induced dysregulation of the Nuclear Factor-kappa B (NF-κB) transcription factor pathway has been linked to IBD pathogenesis. Objective: To assess the current evidence in relation to the contribution of the classical and alternative NF-κB pathways in IBD and to discuss the epigenetic mechanisms that impact on NF-κB function. Methods: A Medline search for ‘NF-kappaB/NF-κB’, in combination with terms including ‘inflammatory bowel disease/IBD’, 'intestinal inflammation', ‘Crohn's disease’, ‘ulcerative colitis’, 'colitis'; ‘epigenetics’, ‘DNA methylation’, ‘histones’, ‘microRNAs/miRNAs’ and ‘short non-coding/long non-coding RNAs’ was performed. Results: Both NF-κB pathways contribute to the chronic inflammation underlying IBD by regulating the inflammatory immune responses and homeostasis of the intestinal epithelium (classical pathway) or regulating bowel inflammation and epithelial microfold (M) cell function (alternative pathway). DNA methylation is a common epigenetic modification in intestinal inflammation, including NFKB1 and RELA loci. Conversely, little is understood regarding epigenetic effects on genes encoding other NF-κB subunits, particularly those of the alternative pathway, and in the context of IBD. However, NF-κB interaction with chromatin modifiers is also seen to be an essential mechanism of regulation of downstream target genes relevant to NF-κB-mediated inflammatory responses. Conclusion: Further research is clearly warranted in this area, as understanding the cell-specific regulation of the NF-κB pathways will bring researchers into a position to achieve more efficient stratification of IBD patients, and more targeted and effective choice of treatment.

scholarly journals Regional Incidence of Inflammatory Bowel Disease in a Czech Pediatric Population

2020 ◽  
Vol 70 (5) ◽  
pp. 586-592
Author(s):  
Petr Jabandziev ◽  
Tereza Pinkasova ◽  
Lumir Kunovsky ◽  
Jan Papez ◽  
Martin Jouza ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Population ◽  
Inflammatory Bowel

scholarly journals P317 Key features of bowel ultrasonography in managing inflammatory bowel disease patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S312-S313
Author(s):  
A Les ◽  
R Iacob ◽  
R Costache ◽  
L Gheorghe ◽  
C Gheorghe
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wall Thickness ◽  
Biological Markers ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Independent Predictor ◽  
Doppler Signal ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract Background Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution. Methods Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS. Results Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p &lt; 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness &gt; 5 mm and for Doppler signal presence in the bowel wall (p &lt; 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up. Conclusion The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.

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